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BDS2 CDS Paedriatric > molar incisor hypomineralisation > Flashcards

molar incisor hypomineralisation Flashcards

1
Q

molar incisor hypomineralisation

A

systemic origin of 1-4 permanent molars, frequently associated with affected incisors

Only teeth MIH effects (first permanent molar and incisors)

Cheesy molars
- Yellow
- Obvious
Can be patches of yellow or white

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2
Q

molar appearance of molar incisor hypomineralisaton

A

Cheesy molars
- Yellow
- Obvious
Can be patches of yellow or white

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3
Q

incisor appearance of MIH

A

Well demarcated - blobs rather than diffuse
- Not symmetrical

Chalky white and yellow/brown parts

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4
Q

prevalence of MIH

A

10-20%

- increasing

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5
Q

hypomineralised

A

disturbance of enamel formation resulting in a reduced mineral content
later in amelogenesis

  • secretory – jelly template
    no issues, right shape
  • mineralisation – jelly to hard enamel
    —-issue here – parts not as strong

cannot bond normally
- different structure to normal enamel, weaker areas

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6
Q

post-eruptive hypoplasia

A

hypomineralised FPMs erupt normal bit with soft enamel, parts fall out – then believe wrong morphology
- think hypoplastic but not truly

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7
Q

bonding issue in MIH

A

cannot bond normally

- different structure to normal enamel, weaker areas

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8
Q

what stage of amelogeneisis is affected in hypomineralisation

A

mineralisation (after secretory stage)

- enamel not as strong

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9
Q

hypoplastic

A

reduced bulk or thickness of enamel
- erupt amorphous (wrong shape - secretory phase wrong, but later mineralisation stage right)

May be:
- True - enamel never formed
- Aquired - post-eruptive loss of enamel bulk
\

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10
Q

bonding to hypoplastic enamel

A

Bond normally

normal enamel structure but not full coverage

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11
Q

what stage of amelogenesis is effected in hypoplastic enamel

A

wrong shape - secretory phase wrong, but later mineralisation stage right

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12
Q

why so difficult to determine aetiology of MIH

A

Unclear diagnostic criteria in classification

Most parents can’t remember details from 8-10 years before
- FPM begins forming before birth to age of 2 - Long time period ago

Variations in quality and completeness of case records

Study populations small

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13
Q

what is the critical period for formation of MIH

A

First year of life generally agreed (disturbance)
- Developmental (not hereditary, or genetic)

Enamel matrix of crown of FPM’s is complete by one year

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14
Q

3 clinical periods of enquiry for MIH

A

prenatal

natal (perinatal)

postnatal

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15
Q

questions to ask regarding prenatal period and MIH

A

Usually ask mothers about their general health in 3rd trimester of pregnancy
- Usually nothing really identified but possible causes can be e.g. Pre-eclampsia, gestational diabetes

no definitive causative factors identified

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16
Q

questions to ask regarding perinatal period and MIH

A

Birth trauma/anoxia
- particularly traumatic - emergency C section, suction cup, forceps, lack O2

Hypoclacemia

Preterm birth
- higher MIH rate than full term

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17
Q

questions to ask regarding postnatal period and MIH

A

Prolonged breast feeding (beyond 6 months)
- 50:50 inconclusive, don’t suggest don’t breast feed to avoid

Dioxins in breast milk
- 1 yes:2 no

Fever and medications (childhood infections: mumps, chicken pox etc)

  • 100% yes
  • antibiotics not cause enamel defect but reason on them does

Rural Vs Urban
- Yes

special care units, respiratory problems

18
Q

measles Incubation period:

A

10-14 days

19
Q

measles symptoms (6)

A 
Fever
Rash
Koplik’s spots
Conjunctivitis (eye – need sunglasses)
Coryza (runny nose)
Cough
20
Q

measles Duration of illness

A

7-10 days

21
Q

measles complications

A

Secondary infection, otitis media (middle ear infection)

bronchopneumonia

Corneal ulcers, stomatitis,

gastroenteritis, appendicitis

22
Q

rubella symptoms (5)

A

mild fever

Maculopapular rash

Generalised lymphadenopathy (swollen gland)
esp. suboccipital nodes

Malaise tired

URTI

23
Q

rubella duration of illness

A

8-10 days

24
Q

rubella complcations

A

rare

Encephalitis - brain swelling arthritis - join swelling
Purpura - severe rashes

25
Q

what has been found to be a possible aetiological cause of MIH

A

Disturbances in nutrition during the first 6 months that may have an effect on MIH

Breastfeeding more > 6months
Late intro gruel > 6months
Late intro infant formula >6months

systemic disturbances in first 2 years of life has an impact

26
Q

depth of effect if appearance is yellow/brown enamel

A

whole enamel layer MIH

- microabrasion

27
Q

depth of effect if appearnace white/cream enamel

A

inner parts of enamel affected

- bleaching so less contrast with normal tissue

28
Q

content of hypomineralised demarcated opacities

A

Higher carbon content, lower Ca, PO4

29
Q

what is neural density like in MIH

A

Significant increases in neural density (nerve tissue) in the pulp horn and subodontoblastic region of MIH samples

More innervation
- more sensitive,
- harder to anaesthetise,
more neural densities

30
Q

is there a difference in immune cell accumulation in MIH teeth

A

yes

Significant increases in immune cell accumulation in MIH samples, especially with post-eruptive enamel loss

31
Q

is there a difference in vascularity in MIH teeth

A

yes

significant increase in vascularity in sensitive MIH teeth
- try and fix issue with more blood flow

32
Q

3 potential pain mechanisms of MIH

A

dentine hypersensitivity

peripheral sensitisation

central sensitisation

DO NOT KNOW MIH PAIN MECHANISM EXACTLY
- know they are more sensitive

33
Q

dentine hypersensitivity in MIH

A

porous enamel or exposed dentine facilitates fluid flow within dentine tubules to activate A-delta nerve fibres
- hydrodynamic theory

34
Q

peripheral sensitisation in MIH

A

underlying pulpal inflammation leads to sensitisation of C-fibres
- more neural C fibres there in first place

35
Q

central sensitisation in MIH

A

from continued nociceptive input

- come from brain, due to continue assault on teeth

36
Q

3 clinical problems due to MIH

A 
Loss of tooth substance
- Breakdown of enamel
- Tooth wear
- Secondary caries
(Perfectly good primary dentition, FPM 6 months has caries – poor caries resistance)

Sensitivity

  • Can be exquisitely sensitive
  • —-More caries as hurt to brush

Appearance (esp anterior, psychological issues)

37
Q

MIH treatment options (4)

A

Composite/GIC restorations
- Make them tougher and more wear resistant

Stainless steel crowns

Adhesively retained copings
- Au, glass, composite

Extraction (8.5 - 9.5 yrs)
- majority of moderate to severe – use their dental age

38
Q

what do you need to see radiographically to extract FPMs

A

Want to see calcification of bifurcation of lower 7 than can extract lower 6s
- Before 7 erupts will drift forwards

Take out upper 6s at same time - Need to so don’t over erupt

  • Potentially crowded – loss of space due to primary molars extraction, keep upper 6s till 7s come through as risk of losing good premolars for space
  • Longer ortho treatment but more natural teeth
39
Q

4 considerations for extractions of HFPMs

A

age (dental age)

skeletal pattern (prevent future ortho problems)

future othrodontic needs

quality of teeth e.g. caries

40
Q

5 treatments of affected hypo-mineralised incisors

A

Acid pumice microabrasion
- Yellow or brown marks removed

External bleaching
- Cant get white chalkiness to go away, but can reduce contrast with rest of tooth

Localised composite placement
- Less likely to eradicate but make less difference between

Full composite veneers

Full porcelain veneers
- Gum level changes between 16 and 20 – so avoid as expose margins and wear tooth down

41
Q

what is required for microabrasion and external bleaching

A

full permanent dentition

- 11-13 yrs

BDS2 CDS Paedriatric (7 decks)

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